New clarifications on the Affordable Care Act’s requirements for preventive care shine light on what exactly plans should cover, and provide advice on how plans should do so. The Departments of Labor, Health and Human Services and the Treasury recently issued guidelines on the topic, with the goal of answering questions “to help people understand the Affordable Care Act and benefit from it, as intended,” according to the Department of Labor’s website.
“As the law has been implemented, issues have been raised by some women and from members of Congress that insurance companies were not covering the contraceptive method recommended by doctors, as well as concerns from issuers that the existing guidance did not provide enough detail about how specific types of contraception should be covered,” the Department of Health and Human Services said in a statement, MSNBC reports.
The law recognizes 18 kinds of contraception, and plans must provide at least one form of contraception within each method, the guidelines say. “Plans may implement cost-sharing for medical management purposes (for example, to encourage the use of generic over brand-name products), but must have an efficient and transparent process in place to make exceptions to those cost-sharing requirements in accordance with an attending physician’s recommendation,” Edward I. Leeds writes for Employee Benefit News.
Though the clarifications on birth control are important, the new guidelines also address transgender patients: “The plan or issuer must provide coverage for the recommended preventive service, without cost sharing, regardless of sex assigned at birth, gender identity or gender of the individual otherwise recorded by the plan or issuer,” according to the guidelines.
They also address what services should be treated at no cost to women who have a history of cancer, but aren’t necessarily noted as being genetically susceptible. “Certain counseling, screening and testing for breast cancer must be provided cost-free to women with a personal history of breast cancer that has not been diagnosed as having a certain genetic link,” Leeds writes.
In answer to these guidelines, Leeds writes, plan sponsors should consider whether they’ll need to adjust their plan documentation or communication. “Sponsors of grandfathered plans remain exempt from the preventive care rules, including this new guidance,” he writes. “Sponsors of self-funded plans may consider whether any of these clarifications carry design and cost implications that they wish to discuss with their vendors or consultants.”